[ In searching for answers, the nation might begin by asking why
their highest rated hospitals do no better at reducing race-based
inequities than anyone else.]
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HEALTH CARE DISCRIMINATION RAMPANT – STILL  
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Mark Kreidler
June 28, 2023
LA Progressive
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_ In searching for answers, the nation might begin by asking why
their highest rated hospitals do no better at reducing race-based
inequities than anyone else. _

, Photo by TopSphere Media on Unsplash

 

Since before the country’s formation, unequal health based on race
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from inferior care and treatment
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life spans
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has been part and parcel
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history. Surveys in recent decades have enabled researchers to bring
those disparities into sharper and sometimes harrowing
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But identifying these issues hasn’t brought the country much closer
to resolving them. And a new report underscores how truly intractable
those problems are — because it brings race-based disparities right
into the safest hospitals in the United States.

According to the report
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which was released this month by the Leapfrog Group, America’s
A-graded hospitals — so denoted because of their superior record of
keeping patients safe from preventable harm — do no better at
reducing racial health disparities than hospitals at the bottom of the
scale.

Would you rather be a patient in an A-graded hospital than, say, a
D-graded one? Of course — and that is true regardless of a
person’s color or ethnicity. Yet even the safest hospitals in the
country still reflect wide differences in health outcomes based on
patients’ skin color.

“The disappointing finding is that A-graded hospitals don’t do
better, for the most part,” said Matt Austin, a Johns Hopkins
medical school faculty member who provides strategic guidance to
Leapfrog on its annual hospital survey. “We really don’t touch on
the why, and I’m not sure we understand the why at this point —
other than the obvious, which is that these inequities in our U.S.
health system have always been present.”

For more than a decade, Leapfrog, a nonprofit watchdog group dedicated
to transparency in health care, has compiled and measured data from
U.S. hospitals and used it to issue safety grades to hospitals on a
traditional A through F scale. The most recent survey, undertaken in
partnership with the Urban Institute, mined the results of millions of
patients, including those in California.

Leapfrog closely studied what it calls “adverse safety events,”
which are problems or complications in both general hospital and
surgery-specific settings, and then looked at the racial and ethnic
breakdowns of those events in three safety-grade cohorts: 

* A
* B
* C/D/F

Across 11 such categories at all hospitals, Black patients had
significantly higher rates of adverse events than white patients in
five, and lower rates in only two. Of particular note was the
difference in surgery-related complications: Blacks experienced higher
rates of: 

* Postoperative Sepsis Infections were 34% higher for blacks than
whites
* Pulmonary Embolisms during surgery are 51% higher
* Postoperative Respiratory Failure were 17% higher than the rates
for whites

Latino patients experienced higher rates of adverse outcomes than
white patients in two of 11 categories and lower rates in four, the
report found.

Most significantly, the disparities didn’t vary much no matter how
well a hospital was graded for safety. “These findings suggest that
the hospitals most adept at achieving safe care overall are no better
at identifying and narrowing inequities in the delivery of that
care,” the report’s authors wrote.

Further, patients with public insurance were more likely to receive
unsafe care than those with private insurance. Medicare patients had
significantly higher rates of adverse events in 10 of the 11
categories studied; for Medicaid patients, it was eight of 11. And
while any number of factors — inferior access to care, difficulty
finding regular doctors — might contribute to the overall health
issues of someone relying on a program like Medi-Cal, even the
safest-graded facilities didn’t make it less likely that they’d
receive unsafe care when they were actually in the hospital.

The results suggest a double whammy for Black patients. According to
the Kaiser Family Foundation, Black residents of the U.S. are more
likely
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have public health insurance than either white or Latino residents.

Austin noted that although the subject has been discussed for decades,
studies such as this one are relatively few. Patients in the A and B
graded hospitals received safer care overall, with fewer adverse
outcomes — but those hospitals’ inability to close the racial and
ethnic disparity gap was glaring.

“There’s certainly a lot of literature out there about some of the
causes of the disparities in general, including cultural competency
(in understanding race-based health differences) among health care
providers,” Austin said in a telephone interview. “The primary
question we wanted to examine was whether the higher-graded hospitals
were able to reduce those disparities. They weren’t.”

The Leapfrog report, though new and focused on hospital care, follows
a long pattern of previous findings on race and health, including
those specific to California. The most recent survey
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the California Health Care Foundation, released in February, found
that Black and Latino patients were far more likely than either white
or Asian Californians to report having had a negative health care
experience in the last few years. Among Black residents who took the
survey, meanwhile, 98% said that making health care more affordable
was “extremely” or “very” important and said that money
concerns are one reason they sometimes don’t see a doctor.

And racism in health care is, sadly, a well-worn topic. Some 20 years
after the publication of the landmark report “Unequal Treatment,”
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entrenched racial disparities in health coverage in the U.S., many of
those involved in producing it told
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health site STAT that little has changed.

“There hasn’t been a lot of progress in 20 years,” Brian
Smedley, a health equity and policy researcher with the Urban
Institute who served as the report’s lead editor, said last year.
“We are still largely seeing what some would call medical apartheid
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The stakes have never been more evident. A report published in May by
the _Journal of the American Medical Association_ put it starkly
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1999 through 2020, the first year of the pandemic, Black Americans
experienced 1.63 million “excess deaths” compared with whites,
representing 80 million years of potential life lost.

Health disparities in the U.S. remain all too real, and as the
Leapfrog report makes clear, they persist even among the
highest-regarded facilities. In searching for answers, both California
and the nation might begin by asking why their safest hospitals do no
better at reducing race-based inequities than anyone else.

_This article was produced by Capital & Main
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_MARK KREIDLER is a California-based writer and broadcaster, and the
author of three books, including Four Days to Glory. He writes
for Capital & Main [[link removed]]._

* For Profit Health Care
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* Systemic racism
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